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Other diagnostic studies (consider ordering based on results of H&P and ECG)

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arrhythmia " sx (4%); asx but signif. arrhythmia (13%); sx but no arrhythmia (17%)
Event recorder (activated by Pt to record rhythm strip): useful for infrequent events, but
problematic if no prodrome; yield 20–50% over 30–60 d of monitoring
LWBK634-c01[01-42].qxd 7/7/10 2:37 PM Page 38 Aptara Inc

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complicated parapneumonic effusions usually require drainage to achieve resolution


empyema * frank pus, also needs drainage to achieve resolution
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BkG0,3d'KfM‡GA>xG>xGM’IBlkGAIBZI.25B;R2&+5NEJM 1995;332:345 3B“GABCƒF
iZGBMB‘=B|GAGAYR>’GAMwM=vMBN‡=;GMBxGiuMGNFŽF{MDBdGA=cDa=Bi‹GAMLBd
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a c  2008;371:126
• &^+GB”GA<G=cMB•M•MBŽNEJM 1991;324:1445&1996;335:1864
3'=2=BNyGLYGAE†=BX1#C+% +1&T+52‰Gi…GBACvFMCMGBC€NBHaMGANR_GGB[G
LNRBdBwIBH}=+%24=++&<+%<41&S1!Q'=Z=MB“GABCƒF23MKlŒ=i\‰Gi…GB
=Z=MB L‡MBdGADBa (2' :' ! ."". ), @ .- " ." ) Im5 ! F) DA
=B„L‡MBŽGB;BGdGA@ .- >liHZGGA =kMBwM<uC1'=+F,;+<* NEJM 1991;324:1445
• 23..B;R‡GA=B”3*  –  I (AJCCM 1999;159:512)
MBwM<uCGNDBaFZNQwNiC c MLBB c BH}= T MLMCF c BH}= T $MHZMF˄BdCEH[N
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EH^M=[GGB{=)7 '! Ž<G>•iHZG0WMBdGADBa! > S T MB•CAC;GMBdGADBa T 
L‡GAYR&4(MJ 2005;330:1243)=5Z.@5eDBCƒNJNvDBCMB•=BCƒGEf=" MNxGLHOŒCi•CiG
"MAf: JAMA 2010;303:1483
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<5k:.:4=AK0V:4S :5Z:446}<  T @o8n@|B;:4NEJM 2000;342:1301
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8,1,*86auma): Gp@EO>~@9q>2>8 %†=Z7<7bB;?<U7B<5IH^MB;<=XB7˄I 1C4B<\A6B $<]B;
<o@F')V-)Q' 7\@†=Z7<Jƒ=.-aW7<CBwI7<|7<IqBa‚H<9C(2' NEJM
 2004;351:327; JAMA 2008;299:637 (wI7<IqBa‚H<9C(@<2C
 • 7A )S T H ;H<]B;?<Z 7n=H<={B7c<~7D<•=
JAMA 2008;299:646 T H|@{HŠJCB;JAMA 2010;303:865
(wI7 H<yc**AT?c(@<2C;†=_•7A1&Z-&a+%)Q'FHg" •
∴ c **BwISc,2' ; ,2' A‡7H=XI (•  (@<2C)
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H<]B;?<Z7c<~7 BtA"0B<dB;??<U7B<5IJxH|@{HŠJCB;NEJM 2006;354:2564
‘ 5H<9H9FaAD<•=ayH/24Y+8}7< Sc 6=wB7<˄B;GCJƒ=7<|8^B;1*NEJM 2006;354:2213
‘ "8,64/+7JrB7[BHF5B<@IsB /8?ACB;AIB;€AMwI/$c?<\?=yAGCUH;@I7CG9
B<=zAHF^B; %†=Z7<7\H<yH<5Ma•=H<9CH<„=;=5BH‰?<=,.?<…=D<UH
 <7U7B;<=XB7˄I7b?7<CH<oM@†=Z7<NEJM 1987;317:1565T H|@{HŠJCB;T H ;H<]B;
?<Z7c<~7 BtA"0B;<=XB7˄IJrB7[BHF5B<7W=C s 2007;131:954
• 8@†=Z7<S T H ;H<]B;?<Z7c<~7 BtA"0??<U7JxH|@{HŠJCB;NEJM 2006;354:1671
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N!7<d57 AT**7\H<yc (2' :' ?T H|@{HŠJCB; & 4"R'1&'[+0`B;TM?8^B;AUM
H<]B;?<ZMJ2007;334:779DFCGH57M7@=BG<ZHHdcB;HŒJxAuHG=B<@ZH8h+%7bB;HdcB;HŒ
   $"’(2' B<dB;c 6=wB7<˄B;JT?<]B;T H|@{HŠJCB;JAMA 2009;302:1977
    ( #% ?B<=xI@†=Z7<AJCCM2002;166:801 7\H<yc (2' H<CUB;
EI5C s 2007;131:1907
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ECM 7\H<y<‹IZ7<HFCB;,.HFcJƒ=a HF}B<dB;?7\H<ŠB;<={ABTCHƒHGCJ˄>
H=]B<?=Z.-H=qDA r 2004;240:595; C s 1997;112:759; a c  2009;374:1351
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HFYUD@’89feB<EI6D=…> S c (2' :'  c d‡dTB=„> JT8\H=}8p>H=>BH>XB@f‹B<
NEJM2008;359:2095
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‘ 2d'+%He'"@+0`+%*D=…>S6HT #'H9C8eM{I96>9xB<NEJM 2003;348:683
LWBK634-c02[01-24].qxd 7/6/10 3:48 PM Page 23 Aptara Inc

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J2'(K#B'!B
• I($2$85'%P'F$&M! ”->J:FG+FCHC8C@• NEJM2001;345:1368
cyHdf‰B<HFIL|BdAHAHFIB<HVA NEJM 2007;356: 21; 86H=:H:FdAD=…>?8rBH=>{HJT ✓ UD
@’8dA1/2+%!>+&)+,UD@’8HAHF HVA2+ ,4E' ?8rB,E' 
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,4E' A H>XI ( ?=>9_B<"?=ƒ>H=Iƒ8>BCHFCD:9C7IH6A>B: c @>|I?=>8rBA†> D
&=>9_B<HFCB<J[B<=drI8=C*0=IL{HByB<G=C8?*0=IL{H H€@H•JCB<T 
• )Iƒ>dxB<HFfeB<8\HU89ŒB<B=f6@7IA>BHFCB<=„>GŽ8NEJM2004;350:2247
• *CF:D>B:D=F>B:fIH>XB=eB9CD6A>B:T @CoBB=•DH&He+%T H€@H•  NEJM 2010;362:779
• 26GCDF:GG>B?{H=‹DBCF:D>B:D=F>B:@>|IH=qD?=]B<fIH={=eBBCF:D>B:D=F>B:@>|I86CNEJM
2008;358:877 8VBB=v8B{I=o"HFeJ˄>H=Iƒ8JuBAo8=86H:8=C@6A>B
• /•GŒB<"?=ƒ>H=uBHF‚B< JY8\H=}c H€@8={H H€@7B= c B<IL8e-/CriCar M 
2005;33:1191 ∴ AŒ8H>XI"7HF•?=>8\H=>{IAUI8eH>A=CoHd‡B<NEJM1999;340:409
• /6I=„>GŽ876BdrIB{I8\'$ -/2+AŒ8H>XI“AA"<HFIL|BH=XA9•8=8\H=}
<VL=o> S c 9_B<AULH=]B<?=Z H <$1NEJM 2006;354:2564; C s 2008;133:252
• >{Bd…>=>IUD ! 8_B<J˄>7>{Bd…>=]=qD S 8\?=pBbB<dUDŽB<7_9•8= C s
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• 0:GH?Z8=H=Z8=0"<>`DH>XB@f‹B<H€@H•JCB<HFCB<*0=IL{H B=fB<'7 H>XB
@f‹B<?{HEIp@>ID=UD8CFH>8CGH:FC>9JAMA2000;283:1038; NEJM2008;358:111
• U8B< 8ŽIHFf˄88=CH=qLcó 8p>H=>B0'H•JCB<HFCB<=G6IG=C8?*0"H H=I " G6I =
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• &=]B<H=qL8p>H=>B0'H•JCB<?=>9_B<8CFH>8CGH:FC>9GG˄A =H=:C;>?ŠHqH8p7B
G=C8?*0 ?HZB=d{BH:GH? H=Z8=0" G=C8?8TB<=„>D=Œ8B=6B= 8TB<9~7‡>B=>~A
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• =L9FC8CFH>GCB: “ A†>“=' ;@I9FC8CFH>GCB: I<=wB<B<TL"&,7BG=C8?*0HFe
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648,/3.4Z8.I(
• 2tB8[BHF6B=8W>T HILHdƒ>0'H•JCB< B=fB< c B<IL8e8=pLAUINEJM 2001;344:699 ?
8p>H=>BH€@H•JCB<B{IB<IL8eH•JCB<@TH=qD+"  " =Cy88=€GIL HoB< NEJM
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• B{I+"  =6LGILd6HoB<AT?8\c CriCar M 2008;36:296
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120 110 100 90 80 70 60 50 40
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7.00 7.10 7.20 7.30 7.40 7.50 7.60 7.70 7.80
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HCO3 !2 mEq c.
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• " UAG S c 6U=G=G'  S 7^eVC”A;7’5G<xAIŒ=GB5A@VH 
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DKA Toan MuM


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Fe <3% Fe >15%
Ethanol Salicylates urine pH >5.3 urine pH var. Ti/$B&
Methanol 5-oxoprolinuria D2 NgM8M
Ethylene glycol H2a lo.ng
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L#E #E -$
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LWBK634-c04[01-20].qxd 7/7/10 2:32 PM Page 19 Aptara Inc

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LWBK634-c04[01-20].qxd 7/7/10 2:32 PM Page 20 Aptara Inc

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LWBK634-c5[01-38].qxd 7/6/10 6:14PM Page 1 Aptara Inc

 
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LWBK634-c5[01-38].qxd 7/6/10 6:14PM Page 2 Aptara Inc

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↑ Fe, nl TIBC
↓ ferritin MCV/RBC <13 ↓ Fe, ↓ TIBC
↑ ferritin
Fe/TIBC <18% basophilic stippling ↑ ferritin
basophilic stippling nguy-
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D!/>Y#
↓ Fe trong tYy ± 2L@4U

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LWBK634-App[01-12].qxd 7/10/10 1:49 PM Page 11 Aptara Inc

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